Glomus tumor is relatively a rare type of tumor that mainly forms in the terminal parts of the body like the fingers and nails.1 These parts of the skin contain glomus bodies or glomus apparatus in the dermis layer of the skin. Glomus body is responsible for the temperature regulation of the body. Experts, though not ultimately sure, opine that due to some distortions in glomus body, apparently non-aggressive tumor cells are formed, which is known as glomus tumor. These tumors look too small and are normally painful in nature. If not treated in time, there is an increase in pain and intolerance to cold water may also be noticed with the passage of time.
What is Glomus Tumor?
A glomus tumor is rare, usually benign, soft tissue neoplasm. The glomus body or glomus apparatus is a part of the dermal layer of the skin – the layer that lies between epidermis and hypodermis. While they are located all over the body, glomus apparatus is present in higher quantities in the fingers and toes. Due to any conditions, if glomus body grows abnormally, it leads to glomus tumors. Glomus tumors are mostly found in the people within the age group of 20 to 50 years of age. Again, women are affected more than the men with glomus tumor.2
Symptoms of Glomus Tumor
Glomus tumors are generally solitary and from outside looks like small lesions. The lesions are usually less than 7 mm in diameter. The vast majority of tumors are found in the extreme parts of the bodies like fingers, wrists and finger-nails, etc. In rare cases, the glomus tumors may exist in other body areas, like in the gastric antrum or glans penis. Glomus tumors are often very painful and tender on palpation, and the pain increases when the affected part comes in contact with cold water. The pain may increase at night, when applying a tourniquet may relieve the pain to some extent. As such there are no exact physical symptoms of glomus tumors, but the above mentioned symptoms are the most obvious ones.
Causes of Glomus Tumor
The exact causes of glomus tumors are still unknown to the researchers, but some experts have claimed that trauma is the most inherent cause of solitary glomus tumors. In case of multiple glomus tumors, defects in the glomus body and defects in the glomulin gene are assumed to be the primary cause of such glomus tumors.
Prevalence Rate of Glomus Tumor
Glomus tumor is not a common issue; it has been found to occur with an assessed annual rate of 1 case per 1.5 million people. As per the available statistics, almost 70% of glomus tumors occur in the hand- more precisely present in the nail bed. The tumor lumps mostly appear solitarily, but can occur in clusters also. Glomus tumors accounts for almost 5% of all soft tissue tumors in the hand.
Pathophysiology of Glomus Tumor
Glomus tumors are hamartomatous proliferations of some muscle cells originating from already existing regular glomus cell.3 Glomus cell populations are mostly found in the fingers where the Sucquet-Hoyer canals are present. These canals play an important part in thermoregulation.
As it is discussed earlier, glomus tumors are mostly visible on the hands and fingers. These tumors can also occur in some areas of the body, where glomus cells are not available. As per the experts, these types of tumors may arise from perivascular cells that can differentiate into glomus cells.
It is mostly found that the glomus tumors form solitarily and sporadically, but some cases are also found when the glomus tumors are formed in multiples. These types of glomus tumor, known as glomangiomas or glomuvenous malformations, are mostly found in the children and adolescents.
Diagnosis of Glomus Tumor
The patients with glomus tumor needs early medical attention, but the problem remains undetected for pretty long period in most of the cases. The lesions are also too small to be identified as glomus tumor at initial stages.
Glomus tumor is accompanied with moderate pain, sensitivity to cold water and point tenderness, but these symptoms are not obvious in all cases. Upon biopsy, the characteristic of the tumor comes forth. The histopathology typically displays a few blood cells, and darkly staining nuclei of the tumor cells.
Except some bony erosion, X-rays or plain radiographs cannot reveal much regarding the glomus tumor. For more clear images, USG is frequently advised to help in right diagnosis of the problem. MRI and CT scan are useful for detecting the lesions in the soft tissues, but for glomus tumors, MRI is not normally advised. CT scan shows non-specific subungual mass.
Treatment of Glomus Tumor
Surgical excision is the only option for curing glomus tumor. The process is not a tough affair, and takes a 15-30 minutes outpatient procedure. During this procedure, the nail is removed, and an incision is made to expose the tumor, and then the tumor is removed. The site is stitched and bandaged accordingly. As per the requirement, medications are prescribed. In due time, the pain and intolerance to cold are relieved, and the nail will grow to its normal structure within 3-4 months.
Prognosis of Glomus Tumor
Glomus tumor has an excellent prognosis. Removal of the tumor results in complete cure of the illness. The relapse of solitary lesions is too low and malignant glomus tumors are not usually found. Some rare cases of malignant conversion within glomus tumors have been detected, which characteristically represent a locally aggressive malignancy with some rare cases of metastases.
Conclusion
Glomus tumor is a benign tumor arising from the dermis layer of the skin beneath the nails of fingers and toes normally. The basic causes are not clear to the experts and researchers; however, it is opined that due to any form of external injury, it forms and proliferates. The diagnosis of this disease is also a critical affair due to its smaller size and less physical appearance. Surgical operation is the only solution against glomus tumor. The surgical operation is not a complicated one and takes 15-30 minutes for completing. The prognosis in glomus tumor is also excellent.
